ASGE Annual Postgraduate Course at DDW: UPPER GI Only (On-Demand) | May 2019-6 Ginsberg_Endoscopic Therapy for Ampullary and Duodenal Adenomas

6 Ginsberg_Endoscopic Therapy for Ampullary and Duodenal Adenomas

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During the 2019 ASGE Annual Postgraduate Course, Dr. Gregory G. Ginsberg discussed the endoscopic therapy for ampullary and duodenal adenomas. These adenomas, which are rare and usually found incidentally, can cause symptoms such as anemia and obstruction. They are distinct from those associated with FAP. Removing these adenomas is challenging due to the technical difficulties involved, the risk of bleeding, and the high risk of complications such as pancreatitis and perforation, especially in older patients with comorbid diseases.<br /><br />For the removal of sporadic non-ampullary duodenal adenomas, Dr. Ginsberg described the process of inspection, injection, resection, retrieval, and hemostasis. He also mentioned the need for clear liquid diet, PPI medication, observation, and structured follow-up after the procedure. He discussed the use of adjunctive ablation therapy for lesions that could not be completely resected, and highlighted the importance of performing follow-up endoscopy to manage any residual or recurrent neoplasia.<br /><br />Regarding ampullary tumors, Dr. Ginsberg explained that they account for 5% of gastrointestinal neoplasms and can be either incidental or symptomatic. Management options include observation with interval imaging and tissue sampling, local excision, or endoluminal papillectomy. The latter technique involves using a snare to remove the tumor, followed by post-papillectomy stenting and the use of indomethacin to reduce the risk of complications such as pancreatitis.<br /><br />Furthermore, Dr. Ginsberg discussed the management of intra-ductal extension and juxta-ampullary lateral extension, and highlighted the importance of careful evaluation, histopathological prognosticators, and communication with the pathologist for accurate diagnosis and management.<br /><br />In conclusion, Dr. Ginsberg emphasized that endoscopic therapy for ampullary and duodenal adenomas is a feasible and effective alternative to surgery in selected cases. It requires specialized equipment and technique, and the outcomes are likely to be better when performed at expert centers.

Keywords

endoscopic therapy

ampullary adenomas

duodenal adenomas

bleeding risk

complications

non-ampullary duodenal adenomas

follow-up

ampullary tumors

endoluminal papillectomy

intra-ductal extension